SMAIF at 20: Continuing the Federal Response to a “Severe and Ongoing Health Care Crisis”

Content From: Timothy Harrison, PhD, Senior Policy Advisor, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human ServicesPublished: November 07, 20186 min read


As we mark the 20th anniversary of the Minority AIDS Initiative (MAI) this fall, I am pleased to announce the FY 2018 “Promoting Innovation to Eliminate HIV-Related Health Disparities for Racial and Ethnic Minorities” awards funded under the Secretary’s Minority AIDS Initiative Fund (SMAIF). For FY 2018, more than $50.2 million has been awarded to support 27 programs and activities led by eight HHS Operating Divisions and Staff offices. These projects reflect current epidemiological data, apply evidence-based HIV prevention and care strategies, and help us advance toward the goals of the National HIV/AIDS Strategy.

The SMAIF is a portion of the larger MAI that allocates funds to the HHS Secretary to support innovative HIV prevention, care and treatment, outreach and education, and technical assistance activities serving racial/ethnic minorities. Our office manages the SMAIF on behalf of the Secretary and the Office of the Assistant Secretary of Health. The MAI legislation also allocates resources directly to CDC, HRSA, and SAMHSA. The MAI was established in 1998 after HIV/AIDS was declared a “severe and ongoing health care crisis” for racial and ethnic minorities. It provided new funding designed to strengthen organizational capacity and expand HIV-related services in minority communities that were and remain disproportionately affected by HIV. (Read more about the SMAIF.)

Two Demonstration Projects

Approximately $21 million of FY 2018 SMAIF resources were allocated to fund two continuing demonstration projects. The CDC-led demonstration project Targeted Highly-Effective Interventions to Reverse the HIV Epidemic (THRIVE) was awarded $16.5 million, for its fourth and final year, to continue activities that support state and local health departments in collaborating with community-based organizations, health care clinics and providers, behavioral health providers, and social services providers to develop comprehensive models of prevention, care, behavioral health, and social services for MSM of color at risk for or living with HIV. CDC awarded grants to seven state and local health departments to conduct THRIVE demonstration projects. The participating jurisdictions are: Alabama, Baltimore, District of Columbia, Louisiana, New York City, Philadelphia, and Virginia. In addition, CDC awarded funds to HealthHIV, a national nonprofit, to provide culturally competent technical assistance, training, and capacity building services to the health departments and their partners.

The second demonstration project, the Multi-Agency HIV and Hepatitis C Screening, Treatment, and Cure Collaborative was awarded approximately $4.5 million of SMAIF funding for the second of three years. This project, led by HRSA’s HIV/AIDS Bureau, is supporting Ryan White HIV/AIDS Program (RWHAP) recipients in Connecticut and San Antonio to develop and implement plans that coordinate multiple partners and strategies aimed at improving the prevention, care, treatment, and cure of HCV among low-income, uninsured, and underserved racial and ethnic minority populations. The ultimate goal of this initiative is to increase the number of people living with both HIV and HCV in each of the awardees’ service areas who are screened, diagnosed, linked to care, treated, and cured of HCV. Components of this initiative include expansion of HCV prevention, testing, care, and treatment capacity among RWHAP-funded clinics, HRSA- and Medicare-certified Federally Qualified Health Centers, and SAMHSA-funded community-based substance use disorder (SUD) and behavioral health treatment providers that predominantly serve people of color living with both HIV and HCV; improved coordination of linkage to and retention in care and treatment for people who are co-infected with HIV and HCV; improved coordination with SAMHSA-funded SUD treatment providers to expand the delivery of behavioral health and substance use treatment support to achieve HCV treatment completion and to prevent HCV transmission and re-infection; and enhancement of health department surveillance systems to increase their capacity to monitor acute and chronic coinfections of HIV and HCV and to enable an HCV Data to Care capacity. A technical assistance and evaluation team supports the two performance sites in documenting outcomes and will disseminate findings, best practices, and lessons learned to all RWHAP recipients and other stakeholders.

These demonstration projects reflect SMAIF’s efforts to support innovation and facilitate systems change by piloting promising models and capturing and disseminating the best practices identified in those demonstrations to address both long-standing and critical emerging issues and to improve HIV prevention and care for the most affected racial and ethnic minorities.

25 Other Supported Projects

SMAIF Awards pie chart
Click to enlarge.

In addition, approximately $29.2 million was allocated to support a total of 25 other SMAIF projects at eight HHS agencies and offices. These awards included support for 19 continuation projects which further our efforts to provide HIV prevention and care services to underserved subgroups by supporting linkage to, re-engagement in, and retention in care; ART adherence and viral suppression strategies; and increased access to and utilization of PEP and PrEP. The programs also aim to improve HIV health outcomes by addressing potential co-morbidities and social and structural barriers, as well as augment outreach, education, technical assistance, and training activities for those at risk for or living with HIV.

Finally, approximately $7.4 million has been awarded to support six new projects to be conducted by eight agencies and offices. These new projects highlight SMAIF’s ability to be nimble in responding to emerging concerns and issues. They also reflect efforts to support capacity building for underserved racial and ethnic minority communities; to conduct population needs assessments, program assessments, and specialized evaluations; and to transform public health systems through the implementation of successful models of HIV prevention and care. The six new projects include:

  • A CDC project to accelerate the dissemination of information, training, and tools to support messaging about HIV treatment as prevention, including the health and prevention benefits of viral suppression, to HIV care providers and consumers focusing on reaching racial and ethnic minorities.
  • A SAMHSA-led project to build capacity around opioids and HIV infections among young minority adults utilizing prevention navigators to coordinate linkage, medical care, prevention and other social supportive services.
  • A joint OMH- and CDC-led project that will partner with state Offices of Minority Health or Health Equity to provide training on the current science around viral suppression; provider awareness; client education and social marketing to increase community awareness; stigma reduction messaging; and social media and digital strategies.
  • A HRSA project to systematically catalog RWHAP and SMAIF-funded interventions that have demonstrated success for improving HIV-related health outcomes for Blacks and Latinos. This project will disseminate the most effective strategies and interventions to HIV service providers, RWHAP recipients, community partners, and other healthcare systems as well as federal partners.
  • A SAMHSA-led collaboration with CDC to integrate the Screening, Brief Intervention, and Referral to Treatment (SBIRT) treatment model into HIV testing, prevention, and treatment at sites under the THRIVE demonstration program.
  • An IHS project to disseminate HIV prevention interventions to American Indian and Alaska Native youth, their families, and the organizations that serve them through improving the implementation and uptake of HIV prevention best practices and models of care.

View a list of all the FY 2018 awards [PDF, 395 KB]. View the pie chart of awards totals by agency.

HIV remains a major problem in the United States and racial and ethnic minorities continue to bear the greatest burden. The 27 projects and activities supported by the FY 2018 SMAIF awards exemplify our commitment to leverage these resources to foster innovation, systems change, and strategic partnerships that will make a significant difference in the HIV/AIDS epidemic.